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Year : 1999  |  Volume : 9  |  Issue : 4  |  Page : 195-196
Images-pulmonary alveolar microlithiasis


1 Department of Radiology, JLN Hospital and Research Centre, Bhilai, India
2 Department of Pulmonary Medicine, JLN Hospital and Research Centre, Bhilai, India

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Keywords: Lung, Pulmonary Alveolar Microlithiasis

How to cite this article:
Dwivedi M K, Pal R K, Borkar P B. Images-pulmonary alveolar microlithiasis. Indian J Radiol Imaging 1999;9:195-6

How to cite this URL:
Dwivedi M K, Pal R K, Borkar P B. Images-pulmonary alveolar microlithiasis. Indian J Radiol Imaging [serial online] 1999 [cited 2020 Aug 10];9:195-6. Available from: http://www.ijri.org/text.asp?1999/9/4/195/28353
Pulmonary alveolar microlithiasis is a rare disease of unknown origin in which calcific concretions collect in the alveolar spaces [1]. The alveolar walls gradually get scarified and slowly, severe physiologic impairment becomes apparent [2]. Most cases are diagnosed in the third to the fifth decade. Though the age range is wide there is some evidence that women are affected more than men in familial cases. There seems to be an equal distribution between the sexes in the sporadic cases [3]. No known cause for the disease has been identified and there appears to be no systemic disorder of calcium metabolism and no evidence for any exposure or immunologic abnormalities. Most authors feel that this is an inborn error of calcium metabolism that is confined to the lungs due to precipitation of these salts [1]. In over 50% of reported cases, a familial association with siblings has been established [2],[3].


   Case Report Top


A forty-two years old man was admitted with a history of cough with expectoration and progressive exertional dyspnea for the last six months. The expectorate contained sand like particles and there was no history of hemoptysis. On examination of the respiratory system harsh breath sounds with bilateral scattered creps were found, more so in the lung base. Clubbing was also present. Sputum for AFB was repeatedly negative.


   Discussion Top


The diagnosis of pulmonary alveolar microlithiasis is mainly radiological and is based on two findings [4].

  1. Characteristic radiological appearance.
  2. Clinico radiological dissociation.


The chest radiograph [Figure - 1] shows diffuse bilateral calcific infiltrates, which are seen predominantly in the lower lung zones. These infiltrates are alveolar in nature and produce an air bronchogram. Radiographic obliteration of heart borders, pulmonary hilum and diaphragmatic outlines, is also visualized. Often, a "black-pleura" sign is seen, due to the differential densities between the calcified lung and the pleural surfaces. CT scan [Figure - 2] confirms the calcific nature of the nodules and the presence of an air bronchogram in both lower lobes. Pleural calcification may also be demonstrated [5].

A chest radiograph is all that is needed for the diagnosis but confirmation with CT scan, scintigraphy or transbronchial lung biopsy can be done.

 
   References Top

1.Meyer HH, Gilbert ES, Kent G. A Clinical review of pulmonary microlitheasis. JAMA 1956; 161: 1153_57..   Back to cited text no. 1  [PUBMED]  
2.Prakash UBS, Basham SS, Rosenow EC.III, Brown ML, Payne WS. Pulmonary Alveolar microlithiasis. A review including ultrastructural and pulmonary function studies. May Clin Proc, 1983; 58: 290_300.   Back to cited text no. 2    
3.Josmen MC, Dodd GD, Jones WD, Pilmore GV. The familial occurrence of Pulmonary alveolar Microlithiasis. AJR 1957; 77: 947_1012.   Back to cited text no. 3    
4.Rabin CB, Baron MG. Pulmonary alveolar microlithiasis: Radiology of the chest. 2 ndsub ed. London: Williams and Wilkins, 1980: 474_76.   Back to cited text no. 4    
5.Wineselberg GG, Bvoller M, SachsM, Weinberg J. CT evaluation of pulmonary microlithiasis. J Comput Assist Tomography 1984; 8: 1029-1031.   Back to cited text no. 5    

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Correspondence Address:
M K Dwivedi
Department of Radiology, JLN Hospital and Research Centre, Bhilai
India
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Source of Support: None, Conflict of Interest: None


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[Figure - 1], [Figure - 2]



 

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